CHAPTER ONE

GENERAL INTRODUCTION

1.0 Introduction

It is widely established that good health is one of the most essential indicators of human development.

So, facilitating proper health service is a prerequisite for furthering human development and without giving proper health care services, human development is not possible.

But, ensuring proper health care service and utilizing the remaining health services is the most complex behavioural phenomenon. (Chakraborty N, Islam MA, 2003). Therefore, health care service utilization is an important issue to be discussed in the public health domain.

In the public health context, it is very significant to examine the factors that affect health-seeking behaviour and health services utilization from individual to the community level. (Rahman M, Islam MM,2011).

Inequalities in access to health care services have been taken considerable attention by various scholars in the present public health research sphere. (Kuo T, Torres-Gil FM 2001)

WHO pointed out that providing at least basic health services for the poor and underprivileged without any barriers ensuring, physical accessibility or acceptability of services universally is meant to be health services utilization? (Gulliford M, Figueroa-Munoz J,2002).

But still, in developing countries, people have less access to proper health care services compared to developed countries it is thus a prime challenge for developing countries to ensure adequate health services for all its citizens particularly for the underprivileged without any differentiation. (Peters DH, Garg A, 2008).

1.1 Background to the study

Utilization of health and medical services is defined as the ways in which individuals respond to ill health and disease.

Many factors may influence this response, including characteristics of the individual and their ability to access the type of resources they may need in their quest to deal with their ill-health. There is a clear distinction in the literature between health care seeking which emphasizes the ‘end point’ use of services and health-seeking which emphasizes the wider ‘process’ (Mackian, Bedri, & Lovel, 2004).

While it is of interest to view health seeking as a wider process, it is beyond the scope of this study to infer causation regarding many of the non-visible processes that affect health and health-seeking behaviour.

In this study, health care seeking is the primary objective and is defined in its broadest terms as relating to health care access, service use, and the way in which people respond to their perceived ill-health (Ahmed, Adams, Chowdhury, & Bhuiya, 2000).

The study is also concerned with the kinds of socio-demographic characteristics that may influence health care seeking such as gender, literacy, education, regular income, and age, as well as access-related concerns.

The current study focuses on ill-health and disease as the literature shows there is little impetus to act in developing countries unless an individual is ill (Atkinson et al., 1999; Hjortsberg, 2003) for reasons including poverty, distance, and perceived benefits (Atkinson et al., 1999a; Buor, 2003; Ensor & Cooper, 2004; Hjortsberg, 2003; Nash Ojanuga & Gilbert, 1992).

Good utilization of health services serves to improve the health status of the population. Studies have shown that the presence of health facilities alone is not enough to guarantee their use as other socio-economic factors could influence access and thus utilization.

Low health facility utilization is often a reflection of poor quality of services (Katung PY 2001) and poor attitude of staff. A study was done in a rural community in Plateau State, Nigeria among 360 mothers revealed that high cost of drugs (29.0%), service charges (19.0%), easy access to traditional healers (39.0%), and difficulty in getting transport to a health facility (30.0%) were the major factors that caused non-attendance at 1 the health facility.

Another cross-sectional household survey assessing the utilization of primary health care (PHC) facilities in a rural community in southwest Nigeria showed that 40.0% of respondents who were ill in the preceding six months visited a PHC facility for treatment, while others relied on self-medication. Education was positively associated with utilization of PHC services.

Maternal and child health (45.4%), prompt attention (23.0%), and appropriate outpatient services (20.5%) attracted respondents to use PHC services. Also, a cross-sectional descriptive study in four rural health centers in Mbeere district, Kenya showed that the proportion of mothers who utilized health services for antenatal and maternity services (Mwaniki PK 2002) was 97.5% and 52.0% respectively.

Perceived factors that were identified as barriers to utilization of health facilities as documented in the Nigerian studies and other studies in Ghana, Ethiopia, Kenya, (Saronga HP 2014, Dalal K, Dawad B. 2009) Tanzania, India and Greece include poor education about when to seek care; poverty; perceived high cost of services; inadequacy of available services such as lack of drugs, basic laboratory services; the inadequate number of healthcare workers; poor quality of care; and proximity to the facility.

Age, gender differences, educational status, and income level have been identified in some studies to determine the frequency of use and comprehensiveness of healthcare packages. Identification of such factors and community healthcare priorities vary from community to community and is usually an important step in designing interventions tailored to community needs.

The current literature acknowledges there are multiple determinants of health, which recognize the role of biology, behaviour, culture, economics, psychological, environmental, and social factors and the interconnectedness of these (Ansari, Carson, Ackland, Vaughan, & Serraglio, 2003; Celik & Hotchkiss, 2000; Hunt, 1994; Thisted, 2003).

In developing countries, these factors are newer considerations as countries with limited resources struggle to cope with mortality and morbidity as a result of communicable disease, injury, poverty, sexual and reproductive health issues, and more recent concerns such as hypertension, heart disease (Naicker, 2003) and diabetes that are more lifestyle-oriented results of development (Correa-Rotter et al., 2004).

However, more recent studies are beginning to discover that unless health and ill-health in less developed countries is considered in this broader context, inequalities will only become more evident (Gwatkin, 2000). Therefore, knowledge of the patterns that influence the use of health and medical services in developing countries is needed to address this.

People’s health should be taken seriously by every nation’s political and health leadership. Comprehensive care promotes good health for women and their families throughout their lives, from prevention of premature delivery and low birth weight to childhood nutrition and immunization and prevention and treatment of chronic conditions such as heart and lung disease, mental health disorders, diabetes, and cancers (Quick et al., 2014).

Like many other countries, Cameroon’s WCBAs have struggled with poverty, 2 unemployment, lack of sufficient social services, and minimal investment in social amenities (Tchombe et al., 2012; Ukpere, 2011). Cameroon’s women who have reached the age of childbearing are some of the most adversely affected demographic populations (Chandra-Mouli, Camacho, & Michaud, 2013).

Poverty and lack of healthcare have mainly affected women living in rural areas who have difficulty accessing public health services due to a number of challenges: (a) distant health facilities, (b) lack of funds to settle medical bills, (c) poor knowledge of public health, and (d) lack of means to reach hospitals (Egbe, 2014). For these reasons, many women often depend on medical aid such as maternal and child healthcare services from health service providers, primarily religious organizations and non-governmental organizations (NGO) personnel who travel to villages (Soh, 2013).

The health of WCBAs in the southwest region of Cameroon is of great concern and limited data exists regarding how women in these regions perceive their health and healthcare access (Deaton & Tortora, 2015).

WCBAs in Cameroon, particularly in poor rural communities, have limited access to healthcare facilities and services that cater to their healthcare needs (Weinger & Akuri, 2007). WCBA does not consider healthcare to be their fundamental human right (Soh, 2013).

To improve modern healthcare awareness and minimize gender inequality in healthcare provision, Cameroon is interested in changing perceptions and access to healthcare among WCBAs (McTavish & Moore, 2015; Soh, 2013).

Efforts to improve healthcare access in the southwest region of Cameroon have received support from independent organizations such as the Cameroon Healthcare Access Program and the WHO (Abrokwah et al. 2016). To effectively evaluate the healthcare access problem, it is important to also understand related challenges to improve the level of health services in the country.

These challenges have led to low levels of acknowledgment of modern health services and reduced access to services among WCBAs. In light of these challenges, this study focuses on understanding perceptions about access to healthcare among WCBAs in the southwest region of Cameroon.

1.2 Problem Statement

People in Cameroon, particularly those in poor rural communities, have limited access to healthcare facilities and services that cater to their healthcare needs (World Bank, 2013).

Although a vast majority of these people have concerns about their health and recognize a variety of factors that endanger their health, they have previously had little information regarding how to seek healthcare services.

Instead, they place the burden of maintaining their health on themselves (Weinger & Akuri, 2007). Therefore, most people will not perceive government healthcare services as an option in maintaining their health.

Mismanaged healthcare facilities as well as women’s socio-cultural status in terms of healthcare access and financial vulnerability impact this population negatively (Soh, 2013) so this study seeks out to understand the factors affecting the health care services in Buea.

1.3 Research Question

1.3.1 Main Research Question

What are the perceived factors that affect the utilization of health care services?

1.3.2 Specific Questions

1. How do people perceive the process of healthcare access through health institutions?
2. How do people perceive the quality of healthcare services offered through healthcare institutions?
3. How do people understand the impact of healthcare services on their quality of life?

1.4 Research Objectives

1.4.1 Main Research Objectives

To identify the perceived factors, affect the utilization of health care services

1.4.2 Specific Objectives

1. To examine the motive behind the choice of healthcare institutions.
2. To identify the services offered in a healthcare institution in Buea.
3. To analyses if healthcare facilities respect their denigrated packages.